Cover Sheet T

TABLE OF CONTENTS
Cover Sheet T
Mental Health Services Act
2012/3 Update – Innovation
Health Care Access and Outcomes
Project
July 16, 2012
TABLE OF CONTENTS
Acknowledgements ................................................................................................................. 1
Exhibit A
County Certification ............................................................................................. 2
Exhibit B
Community Program Planning & Local Review Process......................... .........3
Exhibit C4 Innovation Project Summary....................... ....................................................... 5
Innovation Program Budget....................... ........................................................................... 12
Public Comments: ....................... .......................................................................................... 13
Acknowledgements
VCBH would like to thank the following stakeholders who participated in the
development of this project:
Planning Workgroup:
Karyn Bates
Ratan Bhavnavi
Nancy Borchard
Carolyn Briggs
Gane Brooking
Cece Casey
Carla Cross
David Deutch
Pam Fisher
Laura Flores
Maria Hernandez
Pete LaFollette
Meredyth Leafman
Carol Luppino
Mary McQuown
Irene Mellick
Clyde Reynolds
Curt Rothschiller
Meloney Roy
Jane Sheehan
Mary Stahlhuth
David Swanson Hollinger
Angela Timmons
Dr. Celia Woods
Liz Warren
Mental Health Board; Client Network
NAMI
Mental Health Board
VCBH Housing
Client Network
NAMI
VCBH MHSA
Client Network
VCBH Adults
Turning Point
VCBH
Mental Health Board
VCBH
NAMI
RICA
Mental Health Board
Turning Point
Sheriff’s Department
VCBH, Director
NAMI
VCBH Adults
VCBH MHSA
HCA
VCBH Medical Director
Client Network
Ventura County – 2012/13 Update - Innovation
Page 1
EXHIBIT A
COUNTY CERTIFICATION
County: _Ventura_____________________
County Mental Health Director
Project Lead
Name: Meloney Roy
Name: David Swanson Hollinger
Telephone Number: (805) 981-1881
Telephone Number: (805) 981-8496
E-mail: Meloney.Roy@ventura.org
E-mail: David.Hollinger@ventura.org
Mailing Address:
1911 Williams Drive, Suite 200
Oxnard, CA 93036
I hereby certify that I am the official responsible for the administration of county mental health
services in and for said county and that the County has complied with all pertinent regulations,
laws and statutes for this annual update/update. Mental Health Services Act funds are and will
be used in compliance with Welfare and Institutions Code section 5891 and Title 9 of the
California Code of Regulations section 3410, Non-Supplant.
This annual update has been developed with the participation of stakeholders, in accordance
with Title 9 of the California Code of Regulations section 3300, Community Planning Process.
The draft FY 2012/13 annual update was circulated to representatives of stakeholder interests
and any interested party for 30 days for review and comment and a public hearing was held by
the local mental health board. All input has been considered with adjustments made, as
appropriate.
A.B. 100 (Committee on Budget – 2011) significantly amended the Mental Health Services Act
to streamline the approval processes of programs developed. Among other changes, A.B. 100
deleted the requirement that the three year plan and updates be approved by the Department of
Mental Health after review and comment by the Mental Health Services Oversight and
Accountability Commission. In light of this change, the goal of this update is to provide
stakeholders with meaningful information about the status of local programs and expenditures.
The costs of any Capital Facilities renovation projects in this annual update are reasonable and
consistent with what a prudent buyer would incur.
The information provided for each work plan is true and correct.
All documents in the attached FY 2012/13 annual update/update are true and correct.
_________________________________
Mental Health Director/Designee (PRINT)
__________________________________
Signature
Date
County: Ventura
Date:
Ventura County – 2012/13 Update - Innovation
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EXHIBIT B
COMMUNITY PROGRAM PLANNING
AND LOCAL REVIEW PROCESS
County:
Ventura
Date:
February 27, 2012
30-day Public Comment period: July XX, 2012 – Aug. XX, 2012
Date of Public Hearing: August XX, 2012
Instructions: Utilizing the following format please provide a brief description of the
Community Program Planning and Local Review Processes that were conducted as part of
this annual update/update per Title 9 of the California Code of Regulations, sections 3300 and
3315.
Community Program Planning
1. Description of the Community Program Planning (CPP) Process.
Upon approval of the county’s first two Innovation projects, focusing on outreach and
engagement to underserved communities, the county’s Mental Health Board directed that future
Innovation projects focus on individuals with serious and persistent mental illness (SPMI) who
do not currently access services or supports. This directive came from stakeholder feedback
that, despite significant transformation of the county’s system of care since the implementation
of the Mental Health Services Act (MHSA), there were still individuals with significant needs who
have not benefitted from the systems changes.
An Innovation Planning Workgroup was established to fulfill this directive, with guidance on
membership from the Mental Health Board. As a result, the Innovation Planning Workgroup led
the development of a third Innovation project, “Feed Your Soul,” which was approved by the
county Board of Supervisors on March 20, 2012.
The Planning Workgroup then continued to meet, identifying additional areas of need and
potential innovative approaches to addressing those needs. The Workgroup met on 2/29/12,
3/22/12, 3/27/12, 4/16/12 and 6/5/12. Through these meetings, the workgroup determined the
project priorities and approach, proposing a project would test Innovative approaches to
ensuring health access and outcomes for individuals with SPMI with co-morbid medical
conditions. The Workgroup, at its 6/5/12 meeting, approved the proposed project, which will
target Older Adults and Adults with serious and persistent mental illness who are currently
served in CSS programs.
The proposed project was then presented to and approved by the Community Leadership
Committee (CLC) on 6/25/12. The CLC is composed of community stakeholders from a variety
of sectors. In FY11/12, its oversight role was expanded to now include the approval of MHSA
plans for submission to the Mental Health Board for review and approval.
Finally, the project was presented to the Mental Health Board on July 16, 2012 for approval to
post for 30 day stakeholder review and comment.
2. Stakeholder entities involved in the Community Program Planning (CPP) Process.
Mental Health Board
The Mental Health Board provides overall guidance and oversight for the Community Planning
Process, including final approval to post the Update for Stakeholder review, overseeing the
Public Hearing and final approval of the Update prior to sending to the County Board of
Supervisors for approval.
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EXHIBIT B
COMMUNITY PROGRAM PLANNING
AND LOCAL REVIEW PROCESS
Innovation Planning Workgroup
As described above, the Mental Health Board (MHB) also set the overall priorities for the
remaining Innovation projects, of which this is the second developed. The Planning Workgroup
representation was established by the MHB and included participants from the Mental Health
Board, Recovery Innovations, the Client Network, NAMI, and VCBH staff, including the Director,
Medical Director and Adult Division Manager. More than half the members of the workgroup
were consumers or family members.
Community Leadership Committee
The CLC is composed of stakeholders from a variety of sectors. It includes representation from
public entities, including the Board of Supervisors, directors of the Health Care Agency, Human
Services Agency, Public Health and Probation. Also included are representatives from the
mental health board and its committees, the various MHSA components, education,
underserved communities and the faith based community. At least half of its members must be
consumers and family members, representing the range of ages served by the Department.
Local Review Process
3. Describe methods used to circulate, for the purpose of public comment, the annual update
or update.
This plan is posted on the County’s Behavioral Health Department website for 30 day
stakeholder review and comment from July 17, 2012 through August 16, 2012. An email
announcing the posting was sent to more than 500 community stakeholders. The posting was
announced at the Mental Health Board meeting on July 16, 2012. In addition to being available
on the Department website, the Update is available upon request by calling or emailing the
Department’s MHSA offices. A public hearing will be held on August 20, 2012, at which time
additional comments will be solicited.
4. Include substantive comments received during the stakeholder review and public hearing,
responses to those comments, and a description of any substantive changes made to the
proposed annual update/update that was circulated. The County should indicate if no
substantive comments were received.
TBD
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EXHIBIT C4
Innovation Project Description
County: Ventura
Date: July 16, 2012
Project Name/Number: Health Care Access and Outcomes Project / 4
Project Purpose/Statement of Need:
Innovative programs must address one of the following purposes (per State regulations):
o To increase access to underserved groups.
X To increase the quality of services, including better outcomes.
o To promote interagency collaboration.
o To increase access to services.
An increasing body of research has shown that people with serious and persistent mental illness
(SPMI) have health outcomes that are significantly worse than those of the general population.
Individuals with SPMI have been found to die on average 25 years earlier than those without
SPMI, and are more likely to have high blood pressure, asthma, diabetes, heart disease and
stroke. Adults diagnosed with schizophrenia have a life expectancy that is 20-25% shorter than
the general population, with 60% of premature deaths due to cardiovascular and pulmonary
disease. Specific causes of premature death for people with schizophrenia include low medical
follow up, high rates of tobacco use, high rates of alcohol and illicit substance use, poor diet and
lack of exercise.
Not surprisingly, health care costs for individuals with mental health and substance abuse
disorders who have multiple physical health conditions are significantly higher than that of the
general population. These individuals are more likely to use an emergency room and to be
hospitalized, yet often have been found to have difficulty accessing regular medical care.
During the planning process for this project, stakeholders affirmed the challenges many
individuals with SPMI have in accessing physical health care services, particularly those who
have the most serious mental health issues and who are often isolated, have less social
interaction and are functionally impaired. Consistent with the research, Stakeholders expressed
that these individuals often are not comfortable or are otherwise unable to access even the most
basic health care services and that their medical issues may go untreated and become
exacerbated. This has a negative impact on both their physical and mental health.
As a result, the Stakeholder Planning Workgroup determined that the project should focus on
innovative strategies to promote 1) access to available health care resources for those with
SPMI who are not comfortable accessing care; 2) ensuring care coordination between service
systems, particularly for those individuals with co-morbid medical conditions; and 3) that
consumers are supported to make healthy lifestyle choices, particularly in areas that may
negatively impact one’s physical and mental health.
Project Description:
Project Goal:
This project intends to improve the quality of care for those individuals with SPMI who have
difficulty accessing health care, have chronic medical issues or who do not access regular
primary health care. It will test whether an innovative, holistic approach to empowering
consumers to access health care while ensuring coordinated care between mental health,
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EXHIBIT C4
Innovation Project Description
physical health and other providers leads to improved physical and mental health outcomes for
individuals with SPMI.
Target Population:
This project targets individuals with serious and persistent mental illness, who often have other
physical health problems and may be reluctant or otherwise unable to accessing health care
services in a timely manner. Specifically, these are individuals that have been served by two
programs – the Older Adults Program and EPICS (Empowering Partners through Integrative
Community Services) Intensive Program. These programs have been full service partnerships
under the Community Services and Supports component of the Mental Health Services Act.
However, upon approval of the Innovation project, those CSS programs are being terminated,
and consumers will become part of this new Innovative program.
EPICS Intensive serves approximately 80 adults with SPMI and high utilization of IMDs,
inpatient care and emergency rooms. These are individuals with very significant needs, coming
from or at high risk of homelessness, and who have difficultly accessing traditional services. Of
these, 93% are diagnosed with psychosis, 51% are also dually diagnosed with a substance use
disorder, and at least 15% have endocrinology related conditions. More than half of the
consumers in the EPICS program live in board and care facilities, 14% in room and boards and
9% are either homeless or live in a motel.
The Older Adult program serves approximately 90 individuals over the age of 60, who have
serious and persistent mental illness and who have significant needs. These are individuals
with reduced personal or community functioning, who are often homebound and have difficulty
accessing traditional services. Approximately one fourth live in board and care facilities. Half of
Older Adult consumers are diagnosed with mood disorders and 44% with a dual diagnosis. A
recent analysis of the program found that ALL consumers served in the Older Adult program
had at least one serious medical condition. Most common conditions include:
Hypertension
63%
Arthritis
43%
Heart Condition
39%
Chronic Pain
38%
GI problems
32%
Diabetes
31%
Obesity
23%
Many of these consumers have difficulty or are reluctant to access regular care for these
chronic medical conditions, which, if not treated appropriately, can lead to poor physical health
outcomes, often resulting in decreased mental health status and quality of life.
Description of Activities:
Summary:
a. This project will transform the current treatment teams for each program to and
integrated, holistic care model which support consumers in accessing their own
healthcare and will ensure coordination of care between mental health, physical
health and other providers providing a range of supports to address “whole person.”
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EXHIBIT C4
Innovation Project Description
b. It will incorporate health navigation, to achieve the primary goal of supporting and
empowering consumers to access health care through traditional means. Entire
treatment team will be trained in health navigation.
c. Additional training will support the treatment teams in providing a fully holistic
approach to care, supporting multiple domains of an individual’s well-being as well as
ensuring coordination of care.
d. These strategies will increase the quality of services for consumers, resulting in
measurable improvement in well-being, including both mental health and physical
health outcomes.
Project Elements:
Health Navigation: The entire multidisciplinary treatment team of both the Older Adult and the
EPICS Intensive program will be trained in “Health Navigation.” Through health navigation, the
treatment team will support consumers in accessing and navigating physical health care and in
ensuring treatment and management of physical health conditions. This will provide a strong
link and increased coordination between the consumer, the treatment team and medical
providers.
The goal of health navigation is to help individuals with serious and persistent mental illness
gain the confidence, skills, tools, knowledge and self-empowerment to access and navigate the
healthcare system on their own in order to maintains their health and wellness goals and
improve their overall physical and mental well-being.
As health navigators, treatment team members will have several functions:
• Identify consumers who could benefit from health navigation;
• Conduct an initial and follow up assessments of the consumer’s health and wellness
status as well as his/her experience accessing health care;
• Collaborate to with the consumer, family members and treatment team to establish
health and wellness goals that are consistent with the consumer’s treatment and WRAP
goals;
• Coach the consumer in achieving these goals;
• Assist the consumer in communicating health care needs and progress to the entire
team;
• Assist the consumer in navigating the healthcare system, which may include:
o assisting the consumer in obtaining public benefits,
o making and attending medical appointments, and
o following up on treatment recommendations, labs, further specialty care, etc.
Key to this process will be support to the consumer to become empowered to navigate the
healthcare system, which will include communicating his/her needs to medical professionals
and overcoming discomfort or fear of the experience of going to the doctor. Peers will be
integral to the model and will take a lead role in providing health navigation, which will include
accompanying consumers to medical appointments.
An initial pilot in a nearby county, which used a peer staff in a dedicated health navigator role,
demonstrated positive outcomes, though the sample size was small. The pilot found consumers
participating had decrease in current health problems and symptoms, and reduced use of the
emergency room with increased outpatient service utilization. It is hoped that the approach
being tested in this project will demonstrate positive outcomes as well, while building the
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EXHIBIT C4
Innovation Project Description
foundation in the county for the full integration of physical health and behavioral health care as a
result health care reform.
Care Coordination: Treatment teams will also be trained in coordinated care, with a focus on
ensuring that consumers access appropriate medical care, that medical care is coordinated with
behavioral health care, and that the holistic needs of consumers are met. Particular emphasis
will be placed on individuals with significant physical health issues and those with high health
care utilization, including the use of emergency or urgent care services. This training will guide
the treatment team in working with health care providers to ensure consumers receive the full
range of needed services, through person centered, recovery based approaches which are
complementary to health navigation goals of consumer empowerment.
Health Promotion and Education: As part of the shift to a holistic approach to consumers’
wellness, the project will include health promotion and education in order to encourage a
healthy lifestyle of consumers. Often, social and behavioral factors related to an individual’s
mental health condition contribute to his/her physical health status. For example, low energy
and apathy from depression may lead to social isolation, lack of exercise and poor nutrition, all
of which are associated with greater risk of illness and shorter life span. Smoking is another
example, as 44% of all cigarettes consumed nationally are smoked by people with SPMI. This
project will partner with existing community partners to provide health education and promotion
and to promote wellness activities on topics such as smoking cessation, nutrition, exercise,
stress management, etc.
Existing services provided under CSS by each program will be integrated into the new
Innovation project. For consumers, this will be a seamless transition, as they will be served by
the same treatment team, with services that will be augmented to better address their full range
of needs. As full service partnership programs, both the Older Adult Program and EPICS
Intensive already provide comprehensive, “whatever it takes” services that are primarily
community based. Both programs are staffed by multidisciplinary treatment teams which
include “recovery coaches,” individuals whose lived experience and specialized training provide
a valuable support to consumers. The EPICS team has further training in Assertive Community
Treatment (ACT), which emphasizes wellness and recovery based treatment planning and
intervention, ensuring the appropriate, least restrictive level of care that promotes maximum
independence for consumers. ACT incorporates a team approach to supporting consumers,
which is synergistic to this Innovation project’s team based, integrated approach to supporting
health needs. Staff in both programs have also been trained in techniques of motivational
interviewing, which will support them in the use of health navigation strategies.
Type of Innovative Approach: New, Adaption, Adoption:
This project will be an adaptation of existing models for health navigation and coordinated care.
Peer supported models for health navigation in mental health have recently been implemented
in various settings and are supported as a strategy promoting integrated mental health and
health care systems. However, these models generally have a specific individual – case
manager or peer staff, serving in a specialist role as the health navigator. This project adapts
that approach by including the entire multidisciplinary treatment team in the health navigation
role. Our hypothesis is that this will support a fully integrated approach to ensuring the mental
health team supports the physical health needs of consumers. The shared caseload will
provide for individual and team flexibility in proactive intervention and response to consumer
needs. Additionally, our research did not find evidence that this coordinated approach has been
adapted specifically to full service partnership type treatment approaches, as this project will do,
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EXHIBIT C4
Innovation Project Description
particularly providing predominantly community based services addressing the full spectrum of
an individual’s well-being.
Adherence to MHSA General Standards (Title 9, CCR, Section 3320).
This project is entirely consistent with and supports the MHSA principles in the following
manner:
• Community Collaboration –The project is based on partnership and collaboration,
specifically between the treatment teams for those served and health care and other
related providers.
• Cultural Competence – The project will ensure cultural competence of staff in supporting
the varied cultures of those participating, including ethnicity, language and age.
• Client and family driven – Both programs that will be part of this project are based on a
consumer and family driven treatment approach. This will remain the foundation of the
new, innovative approaches which will be tested during the project. Recovery Coaches
– peer staff who are members of the treatment teams – will play a critical role in
supporting and empowering consumers and will ensure that participation is
individualized, driven by the consumer and focused on each individual’s wellness goals.
• Wellness, resiliency and recovery focus – The fundamental purpose of the project is to
further promote wellness and recovery among those consumers who participate. The
project recognizes that physical and mental health are interlinked, and it will promote
consumer well-being across both domains. Peer staff will reinforce this message,
promoting a recovery orientated environment, reducing stigma and increasing the
likelihood of participation by consumers in the project.
• Integrated service experience – At its foundation, this project supports the integration of
mental health and physical health care for participants, supporting a holistic approach to
wellness and service delivery.
Timeline:
Year 1
• Months 1-3: Implementation Planning and Start Up:
o Ensure project is fully staffed; complete any necessary provider contract
modifications
o Identify and contract with trainer of healthcare navigation and health coordination
o Training of staff
o Development of specific measureable project goals and objectives, evaluation
framework, indicators, measurement tools and data collection protocols
o Development of service delivery protocols and procedures
o Identification of implementation partners who will support project activities.
• Months 4-12: Early implementation (program ramp up)
o Implementation of project activities
o Initial data collection (“pre” measures)
o Gradual increase in number and types of activities during this period
o Data collection of process measures
Year 2 - 4
• Project Operations: - In order to allow sufficient time to fully implement and evaluate the
project, project activities will continue through Year 4. This will ensure participation by a
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EXHIBIT C4
Innovation Project Description
•
•
statistically meaningful number of consumers and time for measurable changes in
wellness outcomes.
Initially the project activities, and corresponding measurement, will focus on the
introduction of the integrated health navigation approach into the treatment team. Over
the duration of the project, additional strategies will be tested, including training of staff
to incorporate broader wellness approaches into treatment and increased coordination
with health care providers.
During this timeframe, intermediate outcome data will be collected and analyzed and
reported to project participants and stakeholders. This data will be used to drive project
changes and expansion.
Final 6 months of Year 4
Evaluation of impact– A thorough project evaluation will be completed, the results analyzed by
the project’s workgroup, and recommendations made to the Department about whether and/or
how to incorporate this project as an ongoing program, likely funded through the MHSA
Community Services and Supports component. The workgroup will also examine what aspects
of the project were not successful in order to assess the potential impact on future Innovation
projects or current VCBH programming. These results will be disseminated to the stakeholder
community.
Project Measurement, Dissemination of Results
This project will include both process evaluation and outcome evaluation components intended
to assess overall success of the activities being proposed.
Process Indicators will examine the use of appropriate medical care, including:
• Improved access to primary health care
• Use of primary health care provider for general medical issues and for management of
chronic medical conditions
• Effective consumer collaboration with medical treatment
• Level of emergency room use and medical hospitalization
• Preventative health care utilization
• Level of independence of consumers in seeking medical treatment
The project will also look at project outcomes - examining whether the well-being has improved
for those served by the project. Measures being considered to assess this include:
• Level of enjoyment or hopefulness, or satisfaction (“I look forward to participating in the
weekly art project.”)
• Pre/Post assessment of mental health outcomes – e.g. BASIS 24, including change in
clinical symptoms, Global Assessment of Functioning, and inpatient psychiatric
hospitalization and use of crisis services.
• Pre/post measures of physical health outcomes including measures of
weight/height/body mass index, blood pressure, glucose, hemoglobin A1C, and lipids.
• Health related behaviors such as tobacco or drug use, exercise and nutrition.
• Other measures including consumer satisfaction, homelessness or incarceration, etc.
Additionally, the project will assess the level of benefit of the project versus its cost, and whether
access to regular and appropriate medical treatment leads to reduced costs. This will be a
critical variable in determining, at project’s end, whether the project is sustainable.
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EXHIBIT C4
Innovation Project Description
Finally, the project will assess the level of professional functioning of the multidisciplinary
treatment team, gauging whether the integrated approach, with the entire team participating in
health navigation activities, provided a more comprehensive service experience for consumers.
Intermediate outcomes will be consolidated and presented to stakeholders at regular intervals
throughout the project. At the project’s conclusion, the results will be presented to stakeholders,
including the Planning Workgroup, to assess whether the project was successful overall and to
solicit stakeholder feedback about whether the project activities should be continued using other
funding.
Ventura County – 2012/13 Update - Innovation
Page 11
Innovation Program Budget
Innovation Projected Revenues and Expenditures
County: Ventura
Fiscal Year:
2012/13
Work Plan #:
Work Plan Name: Healthcare Project
New Work Plan
Expansion
Months of Operation:
Oct'12 - Jun'13
MM/YY - MM/YY
County
Mental Health
Department
Other
Governmental
Agencies
Community
Mental Health
Contract
Providers
Total
A. Expenditures
1. Personnel Expenditures
1,213,405
2. Operating Expenditures
611,222
$1,213,405
161,795
$773,017
3. Non-recurring expenditures
$0
4. Training Consultant Contracts
5. Work Plan Management
6. Total Proposed Work Plan
Expenditures
91,300
$91,300
$0
$1,915,927
$0
$161,795
$2,077,722
B. Revenues
1. Existing Revenues
$0
2. Additional Revenues
a. SDMC FFP
$471,750
$471,750
b. (insert source of revenue)
$0
c. (insert source of revenue)
3. Total New Revenue
$471,750
$0
$0
$0
$471,750
4. Total Revenues
$471,750
$0
$0
$471,750
$1,444,177
$0
$161,795
$1,605,972
C. Total Funding Requirements
Administration @ 15% of $
$202,932
Net Funding Requirement
Prepared by: La Valda R. Marshall
$1,808,904
Date:
7/13/2012
Telephone Number: 805.677.5171
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Public Comments
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